The “gate” to the T-cell is usually closed, inhibiting redundant nonpain and constant nociceptive transmission from the periphery to the T-cell. This phenomenon is usually explained by the “gate-control theory” proposed by Melzack and Wall in 1965, 40 which has since been modified slightly: information traveling to the brain in large-diameter nerves (touch, heat, cold) and information traveling to the brain in small-diameter nerves (C-fibers) have to pass the substantia gelatinosa before reaching the transmission cell (T-cell), which then sends the respective information to the brain. When counterstimulations, such as tactile or vibration stimuli, are sent to the brain, they supersede the afferent input (eg, some RLS/WED symptoms) and modulate those symptoms. Some authors believe that the unpleasant sensations associated with RLS/WED are somatic hallucinations 39 that originate in the brain and are projected into the legs (or the arms). There are also no published papers addressing long-term use of medical devices used for the treatment of RLS/WED. The efficacy of medical devices in reducing periodic limb movement is not addressed in this paper since there are no published data on this subject. Figure 1 shows an overview of current medical devices and their mode of action. This review will focus on the use of medical devices for RLS/WED, their mode of action, safety and tolerability, some patient-focused perspectives, and cost. Conservative or nondrug-related treatment options can be further subdivided into medical devices and no (medical) device. The treatment for primary RLS/WED consists of pharmacological agents (eg, dopaminergic drugs), 7, 8 conservative options, 9 or a combination thereof. 7 The treatment for the latter entails taking care of the underlying conditions, which then, as per definition, should decrease or even abolish RLS/WED symptoms. RLS/WED can be classified as “primary” (genetic or idiopathic), or “secondary” (related to other medical or neurological disorders). 5 Approximately 80% of patients with RLS/WED present with periodic limb movement during sleep, 6 but the finding is not specific to RLS.Īpproaches used to treat symptoms of RLS/WED 4 The symptoms often become worse as the day progresses, leading to sleep disturbances or sleep deprivation, which further result in impairment of alertness and daytime functions. The usual presentation of RLS/WED is characterized by a strong urge to move, accompanied, or caused by uncomfortable or even distressing paresthesia of the legs described as a “creeping, tugging, pulling” feeling. The International Restless Legs Syndrome Study Group 3 developed a five-item “essential diagnostic criteria” questionnaire with which the patient can be diagnosed. As there are no biomarkers or definitive measurable clinical findings that can clearly implicate RLS/WED, its diagnosis is based primarily on subjective complaints. Restless legs syndrome (RLS), or now known by its newer name Willis–Ekbom disease (WED) is one of the most prevalent neurological disorders in Europe and North America, affecting approximately 10% of the population, with women being afflicted almost twice as often as men. Introduction to the epidemiology of restless legs syndrome
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |